Introduction Different approaches to screening and treatment of cervical precancer Anatomical considerations

Anatomical considerations Gross anatomy of female genital organs, External genitalia Internal genital organs Gross anatomy of the cervix Cervical epithelium Squamous epithelium Columnar epithelium Squamocolumnar junction (SCJ)

Physiological changes of the cervical epithelium

Ectropion Squamous metaplasia Transformation zone of the cervix Changes induced by pregnancy Atrophic changes Congenital transformation zone (CTZ)

Neoplastic changes of the cervical epithelium

Genesis of cervical cancer – Role of HPV HPV structure and types Genesis of precancerous lesions and cervical cancer Cervical intraepithelial neoplasia (CIN) Adenocarcinoma in situ (AIS) Cervical cancers

HPV tests – Variation between tests Instruments, consumables, and setup required

for collection of samples for HPV testing (provider-collected) for self-collection of samples for HPV testing

Procedure to collect samples for HPV testing

Sample collected by a health provider Counselling of a woman undergoing HPV testing History taking Preparation for sample collection for HPV testing Steps for inspection of the external genitalia Steps for insertion of the speculum and exposure of the cervix Steps for collection of cervical samples Steps for self-collection of samples Storage of the samples after collection, and transportation to the laboratory

Interpretation of HPV test results Management of women with a positive HPV test result

Management of women with a positive HPV test result The different strategies Triage with cytology Triage with VIA Triage with colposcopy

Treatment of cervical intraepithelial neoplasia – principles Steps to determine eligibility for ablative treatment

Criteria used to determine eligibility for ablative treatment Steps to determine eligibility for ablative treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment Steps for applying Lugol’s iodine to the cervix Pre-treatment assessment

Treatment by cryotherapy

Principles Cryosurgical unit Ancillary instruments and consumables Steps Side-effects and complications Post-treatment advice and follow-up Video

Treatment by thermal ablation

Principles The benchtop model The battery-operated model Complications Video

Using an HPV test as the test of cure in women treated for cervical abnormalities or cervical intraepithelial neoplasia (CIN) Infection prevention

Standard procedures for protection from infection Essential steps for infection prevention in a cervical cancer screening clinic Preparation of 0.5% chlorine solution

Case studies

VIA triage outcome (applicable in screen-and-treat setting only) – negative cases VIA triage outcome – positive cases VIA triage outcome – suspicious of cancer cases

Foreword Acknowledgement Authors Suggested citation Copyright

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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

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Infection prevention – Preparation of 0.5% chlorine solution

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Preparation of 0.5% chlorine solution from dry powder (household bleach)

To prepare chlorine solution of a particular strength, the following formula may be used to calculate the required amount of dry powder (household bleach):
g/L = [% of dilute solution/% of concentrate of active ingredient (calcium hypochlorite) of dry powder] × 1000
For example, to make 0.5% chlorine solution from a dry powder of 35% calcium hypochlorite: [0.5%/35%] × 1000 = 14.2 g. Hence, 14.2 g of dry powder will be required to prepare 1 L of solution.

Materials required for preparation of 1 L of 0.5% chlorine solution:

Plastic bucket (medium-sized) and mug
Wooden stirrer
Teaspoon
Bleaching powder kept in an airtight container
Water: 1 L
Utility gloves
Laboratory apron

Preparation:

Put on a laboratory apron, and wear utility gloves.
Take 1 L of clean water in the plastic bucket.
Measure 14.2 g (~3 teaspoons) of bleaching powder and put it into the bucket.
Stir with the wooden stirrer until a milky white solution is obtained.
Keep the solution covered. The 0.5% chlorine solution is ready for use.

Label: 0.5% chlorine solution prepared on dd/mm/yyyy

Caution:

Chlorine solution must be prepared daily, because it loses strength over time.
Clean water free of organic matter should be used.
Chlorine solution should be prepared in a well-ventilated area.
Wearing of gloves and a laboratory apron is necessary to avoid direct contact of chlorine solution with skin.
Plastic containers should be used for the preparation and storage of chlorine solution.

Preparation of 0.5% chlorine solution from liquid bleach:

Click on the following links to view examples of negative, positive, or suspicious of cancer cases.

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